What is a joint sprain?

Your ligaments are tough, elastic-like bands that connect bone to bone and hold your joints in place. A sprain is an injury to a ligament caused by tearing of the fibers of the ligament. The ligament can have a partial tear, or it can be completely torn apart.   Of all sprains, ankle and knee sprains occur most often. Sprained ligaments swell rapidly and are painful. Generally, the greater the pain and swelling, the more severe the injury is. For most minor sprains, they improved over 4-6 weeks. They do heal themselves, however, your physiotherapist should take a pro active approach to determining if there are any predisposing factors such as a lack of foot stability, and or imbalances, a lack of strength, poor balance, and or poor activity and training choices. FIFA, is world soccer association who have performed research on injuries and have shown good evidence to support a preventative program of kinetic chain exercises for stability and balance. It consists of various single legged movements, transitional balance challenges, and footwork activity that train stability.  

How can physiotherapy and massage therapy to do help sprained joints?

Physiotherapists are trained to assess and treat acute injuries and will be able to determine if you require medical attention. Once the acute inflammation resolves,  Physiotherapy and Massage treatment may comprise of:  
  • Massage of the surrounding musculature and soft tissue
  • Low  Intensity Laser Therapy is also very important to heal the damaged tissues
  • Advise re devices including crutches, braces, heel lifts, and night splints to rest the affected tissues
  • Prescrible stretches – although stretching is not effective on it own
  • Perform joint mobilization
  • Recommend when ice or heat treatment is advised
  • Prescribe exercises to improve strength, flexibility, core stability and balance
  • Provide education advice so we can be strategic and design a personal improvement plan
  • Assist in first aid and anti-inflammatory advice
  • Provide activity modification advice
  • Recommend hydrotherapy
  • Perform a biomechanical assessment that allows for bench marks to correction including teach proper functional movement skills
  • Advise about footwear, training surface, and equipment advice
  • Work with you in planning a gradual return to activity program
   

First Aid Measures for joint sprains

Follow the instructions for R.I.C.E.:  
  • Rest the injured limb. If you have a significant amount of pain and/or swelling do not put weight on the injured area until you have ruled out a fracture. An X-ray may be need to rule this out and your doctor may recommend not putting any weight on the injured area for 48 hours. If you feel that your joint is unstable or if you have a deformity such in the case of a shoulder joint dislocation and or knee cap dislocation go to emergency or to an urgent care clinic as soon as possible for treatment.
  • Active Rest. Don't avoid all activity. Even with an ankle sprain, you can usually still exercise other muscles to minimize deconditioning. For example, you can use an exercise bicycle with arm exercise handles, working both your arms and the uninjured leg while resting the injured ankle on another part of the bike. That way you still get three-limb exercise to keep up your cardiovascular conditioning. As your physiotherapist for help in this area.
  • Ice the area. Use a cold pack, a slush bath or a compression sleeve filled with cold water to help limit swelling after an injury. Try to ice the area as soon as possible after the injury and continue to ice it for 15 to 20 minutes, four to eight times a day, for the first 48 hours or until swelling improves. If you use ice, be careful not to use it too long, as this could cause tissue damage.
  • Compress the area with an elastic wrap or bandage. Compressive wraps or sleeves made from elastic or neoprene are best.
  • Elevate the injured limb above your heart whenever possible to help prevent or limit swelling.
  After two days, gently begin using the injured area. You should feel a gradual, progressive improvement. Over-the-counter pain relievers, such as ibuprofen (Advil, Motrin, others) and acetaminophen (Tylenol, others), may be helpful to manage pain during the healing process. See your doctor or physiotherapist if your sprain isn't improving after two or three days.

   

When do you need urgent medical attention for joint sprains?

When you:  
  • In Severe pain is enough to warrant a significant injury such as a fracture and or growth plate injury.
  • Are unable to bear weight on the injured leg, the joint feels unstable or numb, or you can't use the joint. This may mean the ligament was completely torn. On the way to the doctor, apply a cold pack.
  • Develop redness or red streaks that spread out from the injured area. This means you may have an infection.
  • Have re-injured an area that has been injured a number of times in the past.
  • Have a severe sprain. Inadequate or delayed treatment may contribute to long-term joint instability or chronic pain.
   

How can exercise and physical development help after after joint sprains?

The Kinetic Chain

Our body functions best and with minimal stress when it is in optimal alignment and posture. Proper structural correction is achieved with proper footwear and support. Proper functional mechanics requires skill development and neuromuscular training and is the science of motor learning. The kinetic chain is a integrated functional unit of systems that work interdependently to allow structural and functional efficiency. It is made of the soft tissue system (muscle, ligament, tendon, and fascia), the Neural system ( peripheral nervous system of nerves and the central nervous system or brain), and the Articular system (joints). If any of these systems do not work efficiently, compensations and adaptations may occur in the other systems. A dysfunction in the kinetic chain leads to decreased performance and predictable patterns of injury.  Imbalances may result from postural stress, a pattern of overload, repetitive movement, a lack of core stability, and a lack of neuromuscular efficiency. All functional movement patterns involve deceleration, stabilization and acceleration, which occur at every joint in the kinetic chain and in all planes of motion at varying speeds.   Optimum posture and alignment provides optimal structural and functional efficiency to the kinetic chain. If one component is out of alignment, it creates predictable patterns of tissue overload and dysfunction, leads to decreased neuromuscular control and initiates the cumulative injury cycle. Muscle imbalance leads to abnormal neuromuscular control leads to overloaded tissue and tissue fatigue which leads to inflammation and eventually leads to tissue trauma or injury. The most common patterns of compensation are the Pronation Pattern of the lower body and the Forward Head Pattern of the upper body and these two patterns are the focus of our screen examination and our subsequent corrective preventative exercise plan. Identification of biomechanical imbalances in a way that is specifically related to the multi planner movements and that involves acceleration, deceleration, stabilization and occurs at multiple speeds in those specific body positions and posture activities of daily living.  Assessment of the muscular system (functional anatomy) the articular system (functional biomechanics) and the neural system (motor behavior) becomes important in the prevention and treatment of overuse injuries and repetitive strains. In order to live a healthy and active lifestyle, one has to train their body the way it moves during daily functional movements.

   

Exercise Training and Physical Development

Foot stability and posturing is the most important physical training that you can do to prevent and maintain good foot mechanics and reduce abnormal stresses on the tendons and muscles of the lower extremity. As for Achilles tendonopathy itself, often strength training will cause more tightness and subsequently overload the tendon and make it worse. This overuse injury often does well with soft tissue techniques and laser techniques.  By decreasing inflammation initially, strengthening exercises may be less aggravating and more effective. We must remember that our calves are typically strong and tight and overused simply by virtue of the functional demands placed on these muscles as we ambulate. To prevent this from happening, recovery techniques such as massage should be a part of your regular routine.  

How can low intensity laser therapy help joint sprains?

Low Intensity Laser Therapy (LILT) is the use of monochromatic light. Meditech Bioflex has been producing this technology for 20 years and has an extensive in house clinical lab.   The light source is placed in contact with the skin allowing the photon energy to penetrate tissue, where it interacts with various intracellular biomolecules resulting in the restoration of normal cell morphology and function. This process also enhances the body's natural healing propensities.   Low Intensity Laser Therapy does not heat or cut tissue. Unlike many pharmacological treatments that mask pain or only address the symptoms of the disease, Laser Therapy treats the underlying condition or pathology to promote healing. The technology utilizes superluminous laser diodes to irradiate diseased or traumatized tissue with photons. These particles of energy are selectively absorbed by the cell membrane and intracellular molecules, resulting in the initiation of a cascade of complex physiological reactions, leading to the restoration of normal cell structure and function.   The process is curative and therefore results in the elimination of symptoms including pain. In addition, it enhances the body’s immune system response and facilitates natural healing. The therapy is completely safe and has no adverse side effects. The technology is highly effective in the treatment of musculoskeletal conditions, arthritis, sports injuries, wound healing and a wide range of dermatological conditions. Whiplash injury typically involves injury to muscles, ligaments, and joints and typically involve several levels and a more wide spread area of injury due to the force full nature of the injury. Muscles of the neck, although short, cross over several joints and so the discomfort is generally more global initially. Laser therapy directed by multiple diodes are able to reach these tissues.    

Physiological effects of Low Intensity Laser Therapy

With LILT there is an increased production and release of:  
  • Endorphins which - natural analgesics
  • Cortisol – a precursor of cortisone
  • Growth hormone – instrumental in tissue repair
  • ATP – improves and regulates cellular metabolism
  • An increase in protein synthesis – collagen, DNA, fibroblasts
  • A facilitated venous and lymphatic flow
  • Increased angiogenesis – the elevation of oxygen saturation
  • Enhanced immune response
  These responses are some of the many processes that accelerate cellular regeneration (cartilage, epithelium) and restore normal cell morphology and function. Treatments are typically 25 minutes to over 1 hour depending on the condition and area being treated   The most popular technical / clinical information requested is available on the Meditech website under Laser Reports. You may visit the Meditech website research section directly for detailed abstracts, case profiles and articles on a variety of topics relating to the use of low intensity laser therapy in the treatment of various medical conditions.  

What life style and self-care measures can you do for yourself to prevent joint sprains?

There are many decisions to be made when it comes to the care of and prevention. An experienced practitioner, a well executed assessment process, and a well thought out personal improvement plan can help.

   

Prevention

To reduce your chance of developing joint sprains, follow these suggestions:  
  • Develop Strength and fitness. Often those who develop strains and sprains have are not prepared physically to perform either the volume or intensity of the activity which they participate in. If your goal is to be active, talk to your physiotherapist to help you develop the components of fitness that are most important to the activities that you do.
  • Prepare your muscles to play. Strengthening muscles used in your activity or sport can help them better withstand stress and load.
  • Recover from activity and get ready for the next. Ask your therapist about the strategies that are best for you to recover from your specific activity. Heat, ice, massage, baths, stretching and include.
  • Warm up first. Before you exercise, take time to increase your core temperature and break a sweat and then stretch in order to maximize the range of motion of your joints. This can help to minimize repetitive microtrauma on tight tissues. Remember, regular massage by your physiotherapist and or your massage therapist helps too. 
  • Use proper workplace ergonomics. If possible, get an ergonomic assessment of your work space and adjust your chair, keyboard and desktop as recommended for your height, arm length and usual tasks. This will help protect all your joints and tendons from excessive stress.
  • Mix it up. If one exercise or activity causes you a particular, persistent pain, try something else. Cross-training can help you mix up an impact-loading exercise, such as running, with lower impact exercise, such as biking or swimming.
  • Improve your technique. If your technique in an activity or exercise is flawed, you could be setting yourself up for problems with your tendons. Consider taking lessons or getting professional instructions when starting a new sport or using exercise equipment.
  • Ease up. Know your body. If you are not fit to perform the activity ease up, avoid activities that place excessive stress on your tendons, especially for prolonged periods. If you notice pain during a particular exercise, stop and rest. If you are unable to progress and develop your sport, seek help from a physiotherapist who understands how to develop athletes.
   

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